1Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland
Background:
Pulmonary artery embolism (PE) is associated with significant mortality and remarkably often subject to misdiagnosis, which additionally adversely affects prognosis. Disease severity and corresponding prognosis are strongly dependent on the risk constellation and determine the therapy. While the study and recommendation situation for patients with a high-risk classification according to the current ESC guidelines is quite clear, an individualized treatment strategy is by far not as clear for patients of the intermediate-high risk constellation. The aim of this retrospective "single-center/single-arm" study was to investigate the extent to which interventional mechanical thrombectomy using the FlowTriever system (Inari Medical, California) influences short-term clinical, laboratory and hemodynamic findings in patients with symptomatic PE during hospitalization.
Methods:
In the presented study, we retrospectively analyzed clinical, laboratory and hemodynamic parameters in 32 patients with symptomatic PE who underwent mechanical thrombectomy using FlowTriever device following evaluation by the in-house LERT. In the observation period between 07/2021 and 01/2023 only patients with symptomatic PE confirmed by CT pulmonary angiography and classified as intermediate-high or high risk based on the presence of both imaging signs of right ventricular dysfunction and elevated cardiac biomarkers with existing hemodynamic instability where appropriate were included. Main outcome measures were periprocedural changes in vital signs and respiratory status, hemodynamic improvement in the small circuit, right ventricular function and early laboratory changes in cardiac and systemic biomarkers.
Results:
There was an immediate and remarkable reduction in increased heart rate, pulmonary arterial pressure and RV/LV-ratio postprocedurally and in early clinical follow-up, as well as improvement in arterial oxygen saturation and demand. In the present study, changes in cardiac biomarkers and lactate in patients with PE and intermediate-high risk were investigated for the first time before and after mechanical thrombectomy with an impressive decrease of hsTroponinT and lactate in the sense of a halving at the time of early follow-up after 24 h compared with the findings before mechanical thrombectomy.
Conclusion:
Interventional mechanical thrombectomy using the FlowTriever system is highly effective and at the same time safe to use in patients with acute PE and intermediate to high-risk constellations. Besides the consistent results with respect to respiratory and hemodynamic improvements the present study shows for the very first time an association between mechanical thrombectomy and an immediate and significant decrease in both specific myocardial and systemic biomarkers, for which prognostic relevance and a predictive probability for PE-associated complications in the acute phase of PE has been demonstrated repeatedly. Therefore the reduction of both parameters should be considered as an important surrogate parameter for respiratory and hemodynamic improvement with outcome-relevant potential and elevated levels might be included in the preinterventional consideration which patients in the analyzed cohort should be offered interventional approach via mechanical thrombectomy.